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Biomedical subjects

C P O'Brien

Publications and source records attributed to C P O'Brien.

At least 91 records · Page 5Linked to original sources
PubMed1994

Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services.

This study examined the patient and treatment factors associated with 6-month outcome in 649 opiate-, alcohol-, and cocaine-dependent (male and female) adults, treated in inpatient and outpatient settings, in 22 publicly and privately funded programs. Outcomes were predicted by similar factors, regardless of the drug problem of the patient or the type of treatment setting or funding. Greater substance use at follow-up was predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Better social adjustment at follow-up was negatively predicted by more severe psychiatric, employment, and family problems at admission and positively predicted by more psychiatric, family, employment, and medical services provided during treatment.

Adult↗
PubMed1994

Desipramine treatment for cocaine dependence. Role of antisocial personality disorder.

As a test of the efficacy of desipramine (DMI) in the treatment of cocaine dependence, 59 cocaine-dependent males, maintained on methadone for the treatment of opiate dependence, completed a 12-week, random-assignment, placebo-controlled trial of this medication. At the end of treatment, there were no overall differences between the placebo and DMI groups on a range of outcome measures, including urine toxicology tests. However, an interaction between psychiatric diagnosis and outcome was seen when the sample was divided into those with (51%) and those without (49%) antisocial personality disorder (ASP). Patients with ASP made few gains with either DMI or placebo. Those without ASP made a number of gains with DMI but not placebo, particularly in the areas of psychiatric symptoms, legal status, and family problems. DMI had a significant effect on the psychiatric symptoms and personal adjustment problems, but not the cocaine use, of non-antisocial cocaine abusers. The negative influence of ASP that has been seen in studies of psychosocial therapies for substance-use disorders may also apply to pharmacological therapies.

Adult↗
PubMed1994

Effectiveness and costs of inpatient versus day hospital cocaine rehabilitation.

We compared the effectiveness and costs of day hospital (DH) versus inpatient (INP) rehabilitation for cocaine dependence. The research subjects were 111 inner city, lower socioeconomic, primarily African-American male veterans who qualified for a diagnosis of cocaine dependence and presented no acute medical or psychiatric conditions requiring inpatient treatment. Fifty-six men were randomly assigned to 1 month of DH rehabilitation (27 hours of weekday treatment weekly), and 55 were assigned to 1-month INP rehabilitation (48 hours of scheduled treatment weekly). Treatment outcome was evaluated 7 months after admission into treatment (92% of the subjects), and a cost analysis was performed. A significantly greater proportion of INP subjects (89.1%) completed treatment than did DH subjects (53.6%). Significant improvements in substance use, psychosocial functioning, and health status were found 7 months postadmission for both groups, but there was little evidence of differential improvement between groups. Urine toxicology findings were consistent with the self-report data in showing improvement from baseline, but no group differences in cocaine use. The groups did not differ significantly in post-rehabilitation aftercare participation or in relapse to additional treatment. DH treatment costs were 40% to 60% of INP treatment costs, depending upon the measure used.

Adult↗
PubMed1994

Overview: the treatment of drug dependence.

Addictive disorders resemble other chronic medical disorders in that they are characterized by relapses and remissions. This central feature of the addictions is addressed by many of the contributors in their individual chapters. There are also several specific points raised in the chapters which merit further discussion. For instance, any assumption that long-term anti-anxiety treatment with benzodiazepines implies a form of dependence that requires treatment could be set against an alternative view that there may be appropriate medical/psychiatric indications for such prolonged treatment. There are also interesting questions which deserve discussion surrounding the debate over treatment setting for opiate dependence treatments. The paper by Johns presents a case for inpatient treatment whereas in the United States long-term methadone maintenance is seen as one of the most effective treatments. Given the complexity of the bio-psycho-social mechanisms involved in addiction, a combination of therapeutic approaches tailored to individual needs should probably continue to be the guiding principle.

Follow-Up Studies↗
PubMed1994

Treatment of alcoholism as a chronic disorder.

Alcoholism is a common disorder that tends to be chronic and relapsing. Although there is clear evidence that treatment can be expected to induce a period of remission or at least decreased symptoms, treatment of alcoholism is generally regarded as unsuccessful. Alcoholism should be approached as a chronic medical disorder such as diabetes or arthritis. Complete abstinence is the preferred goal, but "cures" or permanent abstinence from alcohol are rare. In this model, treatment benefits may be measured by length of remission, reduction in alcohol use, improvement in health and enhancement of social functioning. Treatment continues over a period of years, mainly on an outpatient basis with increasing intensity if symptoms recur. Medications that reduce craving for alcohol or diminish the euphoric effects of alcohol would be very helpful in the management of this chronic disorder. Pre-clinical studies have produced evidence for involvement of the endogenous opioid system in the reinforcing effects of alcohol. Recent controlled clinical trials of the opiate receptor antagonist naltrexone suggest that medications of this type may improve the results of treatment for alcoholism.

Adult↗
PubMed1993

The effects of psychosocial services in substance abuse treatment.

OBJECTIVE: To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients. DESIGN: Random assignment to one of three treatment groups for a 6-month clinical trial: (1) minimum methadone services (MMS)--methadone alone (a minimum of 60 mg/d) with no other services; (2) standard methadone services (SMS)--same dose of methadone plus counseling; or (3) enhanced methadone services (EMS)--same dose of methadone plus counseling and on-site medical/psychiatric, employment, and family therapy. SETTING: The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center. SUBJECTS: Ninety-two male intravenous opiate users in methadone maintenance treatment. RESULTS: While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the trial because of unremitting use of opiates or cocaine, or medical/psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than did the SMS group. Minimum methadone services subjects who had been "protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks. CONCLUSIONS: Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.

Combined Modality Therapy↗
PubMed1993

Developing treatments that address classical conditioning.

Repetitive use of psychoactive drugs produces a variety of learned behaviors. These can be classified in the laboratory according to an operant/classical paradigm, but in vivo the two types of learning overlap. The classical CRs produced by drugs are complex and bidirectional. There has been progress in classifying and predicting the types of CRs, but little is known of mechanisms. New techniques for understanding brain function, such as microdialysis probes in animals and advanced imaging techniques (positron emission tomography and single photon emission computerized tomography) in human subjects, may be utilized in conditioning paradigms to "open the black box." Because the existence of CRs in drug users is now well established, clinical studies have been instituted to determine whether modification of CRs can influence clinical outcome. A recently completed study in cocaine addicts has produced evidence that outcome can be improved by a passive extinction technique over an 8-week outpatient treatment program.

Animals↗
PubMed1993

Cue reactivity and cue reactivity interventions in drug dependence.

Despite a venerable history dating back to Pavlov and countless testimonials from patients such as those in the opening paragraphs of this chapter, there is much that remains to be learned about drug signals and, particularly, about ways of reducing their adverse effects on human drug users. There is a substantial amount of data showing increased craving and signs of physiological arousal to drug-related versus neutral cues in drug users for both drug classes reviewed here. Additional controlled studies will be useful in refining which responses among those studied are, in fact, conditioned in origin and therefore can be subjected reasonably to learning-based interventions. Most attempts to modify cue responsivity for clinical benefit have met with only modest success, and there is ample room for creative, but controlled, treatment-outcome studies. In recent years, several other groups have joined in the effort to understand drug-related cue reactivity, extending the research area to alcohol and nicotine (Monti et al. 1987; Niaura et al. 1988, 1989; Cooney et al. 1984; Hodgson and Rankin 1982; Drummond 1990; Laberg 1990). The interested reader is referred to several additional reviews of cue reactivity and cue exposure research related to alcohol and nicotine (Niaura 1988; Drummond 1990; Laberg 1990), opiates (Powell 1990), opiates and cocaine (Childress et al. 1988b; O'Brien et al. 1990), and all the preceding areas (Rohsenow et al. 1991).

Behavior Therapy↗
PubMed1993

Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up.

Our objective was to determine the prevalence and incidence of human immunodeficiency virus (HIV) infection and related risk behaviors among opiate-abusing intravenous drug users (IVDUs) either in or out of methadone treatment. The subjects, 152 in-treatment and 103 out-of-treatment intravenous opiate users, were followed prospectively for 18 months. Behavioral and serologic assessments were made at 6-month intervals, with complete information available on 89% of the sample. Subjects were recruited from a single methadone maintenance program and the surrounding neighborhood in north-central Philadelphia. At baseline, the HIV seroprevalence rate for the total sample was 12%: 10% for the methadone-maintained group and 16% for the out-of-treatment group. Out-of-treatment subjects were injecting drugs, sharing needles, visiting shooting galleries, and practicing unsafe sex at significantly higher rates than in-treatment subjects. Follow-up of HIV-negative subjects over the next 18 months showed conversion rates of 3.5% for those who remained in methadone maintenance versus 22% for those who remained out of treatment. The sixfold difference in rate of seroconversion between the two groups suggests that although rapid transmission of HIV still occurs, opiate-abusing IVDUs who enter methadone treatment are significantly less likely to become infected. In contrast, those opiate addicts who do not enter treatment are at significantly higher risk of contracting and spreading the disease. Implications for developing additional risk interventions for out-of-treatment IVDUs are discussed.

Adult↗
PubMed1993

Persistent cognitive deficits attributed to substance abuse.

This article exemplifies the major difficulties inherent in carrying out and interpreting human drug research. The information available about the long-term consequences of opiate use remains unclear. In fact, an overall summary of the persistent cognitive effects of long term drug use yields vague and tentative information (Table 2). An explanation of some of the methodologic constructs that have led to the majority of unclear conclusions may be helpful. 1. Baseline. One such important factor in providing an accurate assessment of the possible effects of long-term drug use is to have knowledge of the user's cognitive capacity before exposure to drugs. Such baseline information might be available from school records. 2. Repeated testing. Additionally, it is essential to have control groups and conditions, whereby the groups receive nearly identical testing on repeated occasions to assess whether findings remain consistent. 3. Observed Subjects. In choosing the subjects, polysubstance users are probably the most convenient group of individuals to study because of ease of availability, but very little about the effects of one specific drug class compared to another will be learned. Users do have decided drug preferences and ideally researchers should observe a user over a period of time with repeated urine testing to determine the pattern of use and as much information as possible about the dose. An adequate age range in both drug users and control subjects is helpful. 4. Age Range. One must control for the effects of aging, but if all of the subjects are very young, subtle cognitive deficits may be missed. If, however, subjects are too old, acute or chronic physical conditions that cause cognitive deficits may be impossible to differentiate from long-term drug effects. 5. Choice of Test. It is essential to match the appropriate test to the dependent variables being assessed. 6. Length of abstinence. For valid testing, subjects should be drug free confirmed by toxicology. The best studies have the longest periods of abstinence in a protected environment where drugs are not available. Recovery of function may occur weeks or months after last exposure to drugs. These standards are difficult to achieve, but many studies that have failed to attend to these issues have involved large expenditures of effort with little or no new knowledge as the outcome.

Animals↗
PubMed1992

Classical conditioning in drug-dependent humans.

Repetitive use of psychoactive drugs produces a variety of learned behaviors. These can be classified in the laboratory according to an operant/classical paradigm, but in vivo the two types of learning overlap. The classically conditioned responses produced by drugs are complex and bi-directional. There has been progress in classifying and predicting the types of conditioned responses, but little is known of mechanisms. New techniques for understanding brain function such as micro-dialysis probes in animals and advanced imaging techniques (PET and SPECT) in human subjects may be utilized in conditioning paradigms to "open the black box." Because the existence of conditioned responses in drug users is now well established, clinical studies have been instituted to determine whether modification of conditioned responses can influence clinical outcome. A recently completed study in cocaine addicts has produced evidence that outcome can be improved by a passive extinction technique over an 8-week outpatient treatment program.

Animals↗
PubMed1992

Naltrexone in the treatment of alcohol dependence.

Seventy male alcohol-dependent patients participated in a 12-week, double-blind, placebo-controlled trial of naltrexone hydrochloride (50 mg/d) as an adjunct to treatment following alcohol detoxification. Subjects taking naltrexone reported significantly less alcohol craving and days in which any alcohol was consumed. During the 12-week study, only 23% of the naltrexone-treated subjects met the criteria for a relapse, whereas 54.3% of the placebo-treated subjects relapsed. The primary effect of naltrexone was seen in patients who drank any alcohol while attending outpatient treatment. Nineteen (95%) of the 20 placebo-treated patients relapsed after they sampled alcohol, while only eight (50%) of 16 naltrexone-treated patients exposed to alcohol met relapse criteria. Naltrexone was not associated with mood changes or other psychiatric symptoms. Significant side effects (nausea) occurred in two naltrexone-treated subjects, and one naltrexone-treated subject complained of increased pain from arthritis. These results suggest that naltrexone may be a safe and effective adjunct to treatment in alcohol-dependent subjects, particularly in preventing alcohol relapse.

Adult↗
PubMed1992

Desipramine treatment of cocaine dependence in methadone-maintained patients.

We performed a double-blind, placebo-controlled, randomized 12-week trial of desipramine hydrochloride treatment of cocaine dependence among methadone-maintained patients. Fifty-nine patients completed the 12-week medication trial (36 received desipramine and 23 received placebo), and 94% were recontacted 1, 3, and 6 months after treatment. There were significantly more dropouts in the desipramine than in the placebo group. Baseline to 12-week comparisons of Addiction Severity Index interview data indicated that both groups showed improvements. At 12 weeks, the desipramine group showed significantly better psychiatric status than the placebo group but did not differ from the placebo group on any of 21 other outcome measures, including cocaine use. During the 12-week medication phase and at the 1-month follow-up evaluation, urine toxicology screenings showed no significant difference between groups, but the placebo group had significantly less cocaine use at both the 3- and 6-month follow-up points. We conclude that desipramine has few benefits with regard to control of cocaine use in this population.

Adult↗
PubMed1992

Psychotherapy for cocaine dependence.

Dependence on cocaine is a new disorder for contemporary US clinicians. Until the 1980s sufficient quantities of the drug were not available to produce a true dependence. Thus far the only models for pharmacological intervention involve an interaction between medication and psychotherapy; that is, medication may be able to facilitate a drug-free interval during which time the patient can be engaged in psychotherapy. Psychotherapy programmes for cocaine dependence have generally been modelled on group-oriented treatments of the type used by Alcoholics Anonymous. Controlled studies of therapy programmes for cocaine dependence are currently being conducted and one prospective random-assignment study comparing day hospital and in-patient rehabilitation shows generally good results. Behavioural treatments aimed at reducing or extinguishing conditioned responses in cocaine addicts have also shown efficacy in a controlled study. More general relapse prevention procedures including rehearsal and role-playing are also used in the treatment of cocaine dependence. Combinations of psychotherapy and pharmacotherapy have so far shown the most promise in the treatment of this disorder.

Ambulatory Care↗
PubMed1992

Developing and evaluating new treatments for alcoholism and cocaine dependence.

Progress in the treatment of any disorder requires the development of methods for evaluation as well as the development of potentially effective new treatments. In this chapter we briefly describe a new instrument to be used in the measurement of substance abuse treatment, the Treatment Services Review. Some of the potential problems in evaluation research are discussed, such as the tendency for more severely ill patients to be more willing to give up their right to choose treatment and agree to randomization. These unexpected tendencies in study volunteers limit the generalizability of treatment research. Evaluation techniques are illustrated by two studies comparing inpatient and outpatient rehabilitation. The results for both alcohol dependence and cocaine dependence were positive, but there was no evidence of a significant advantage for one treatment environment over the other. This has important implications for program funding. We also describe our search for a new treatment technique based on a conditioning model for cocaine dependence. Pilot studies suggested an improvement in treatment outcome for the patients receiving the experimental treatment, and therefore, a prospective study with random assignment was conducted.

Alcoholism↗